McDonald, T. A. (ACKNOWLEDGE Thompson, R. (CEO), Kwok, C (DCEO)), 2008
Better Practice Conference, Sydney
What is the better practice initiative?
Issues associated with the costs and benefits of allied health services for residents prompted the question “Is there a link between residents’ physical capacity and the quality of life they experience?” Extensive allied health services had been provided for many years at the Veterans’ Village, but no evidence had been gathered on the outcomes for residents or whether their quality of life had been altered.
What was the trigger for this initiative?
Following a search of the literature and industrial publications, no evidence was found of any program linking the monitoring of both quality of life and physical function in residents. The intuitive assumption is that these two aspects of living are mutually dependent but observational evidence of residents at the Village seemed to be counter-intuitive. The matter was referred to the Professor of Ageing for investigation and recommendations.
What aspects of this better practice initiative makes it unique?
Background data collected over several years by allied health staff were examined and found to by inconclusive in terms of either factor. A convenience sample of 40 residents across 8 hostels was selected and assessment data on physical function collected. Concurrently, a modified quality of life scale was developed and conducted on these 40 residents. These evaluations occur four times per year on the same sample (replacement of residents at attrition is done to maintain sample spread). Analysis of dual data gathered since 2005 demonstrates that there is no predictive link between age, gender, physical function and quality of life however all scores for quality of life have remained in the highest percentile despite the inevitable decline associated with ageing physiology.
What results and evidence support your initiative?
Prior to implementing the Positive Connections program staff attitudes and perceptions were tested on the themes of (i) giving individualised quality care; (ii) knowing and catering to personal preferences of confused residents; (iii) Accessing background information about residents; and (iv) team and family expectations of staff. Three months following implementation staff testing plus interviews were again undertaken and revealed changes such as (i) greater understanding and respect of residents and their value systems; (ii) feeling less intimidated by residents who exhibit challenging behaviours as a result of war service and dementia; (iii) confidence that individualised care is possible for each resident; (iv) better understanding and management of topics that prompt positive or negative recollections about war service; (v) job satisfaction derived from improving beyond ‘good care’ for people with special needs.
What are the key success factors to making this initiative work?
The initiative brought unusual scrutiny upon the allied health team who conduct assessments and therapies across the ANZAC Retirement Village. The professionalism of the allied health team in working with researchers to identify telling indicators of physical capacity and then to conduct quarterly assessments, is to be admired. Functional testing of four measures is carried out by allied health and quality of life assessment done within the same two-week period by either therapy aides or clinical care staff. These data are forwarded to the researcher where they are analysed and a report provided to the Resident Services Committee, the allied health team and managers of each hostel. The communication of results is important to enable all involved to appreciate the value of this information on resident outcomes.
What were the challenges and how were they overcome?
Allied health staff were concerned that that project could be related to ongoing funding of therapy programs because of changes in federal funding for aged care residents. Management commitment to the therapy program had been demonstrated for many years and reassurance was provided as necessary. The quality of life scale was developed by Professor Tracey McDonald from research on people with no cognitive problems and as such marginalised those with mental confusion and increased dependency. The modified version of several of these established scales enables the inclusion of all residents and therefore also, some comparative work to the undertaken between the different testing sites. The data provided from the current scale has proven to be valid in terms of case differentiation and analysis. Resident attrition from natural causes was an expected aspect of the sampling between hostels. A process was devised whereby sample vacancies could be filled to maintain the overall gender and site balance.
Outline the strategies involved in implementing this initiative.
Essentially the strategies involved (i) being open to feedback by managers and staff on issues of concern to them; (ii) allocation of resources to investigate the issues raised and to produce evidence that could be transferred to practice; (iii) designing and modifying assessment tools that would provide specific information; (iv) establishing a data collection, reporting, analysis and results distribution system that meets all information needs; (v) commitment to the program as an ongoing feature of information systems across the Village.
CITATION McDonald, T. A. (2008) Non-technology systems for monitoring the quality of residents’ lives and their physical capacity. Better Practice Conference. National Aged Care Standards and Accreditation Agency, Sydney